Cedar Study Finds a Growing Mismatch Between Healthcare Billing Systems and Today’s Patients

New research shows that financially at-risk and uninsured patients are underserved by billing experiences built for a more stable coverage environment

New York - March 31, 2026 — Healthcare billing has come a long way. 90 percent of patients receive bills through their preferred channels. 76 percent say payment is convenient. But new research from Cedar suggests those gains were designed for financially stable patients, and are not reaching those under the greatest financial strain.

Cedar’s newly released Healthcare Financial Experience Study, based on survey responses from 4,150 adults and insights from 1.5 billion patient interactions, points to a widening divide in how patients experience medical billing. Patients with lower financial capacity and inconsistent coverage face significantly greater difficulty navigating and paying their bills, yet are underserved by existing billing approaches. 

At the same time, provider exposure from financially vulnerable patients is rising. Nearly 40 percent of collectible dollars on Cedar’s platform now come from uninsured patients, up 54 percent in three years. With expiring ACA subsidies and Medicaid policy changes expected to leave millions more facing coverage instability.

“Providers have been navigating the high-deductible landscape and rising patient out-of-pocket costs for some time,” said Florian Otto, Chief Executive Officer of Cedar. “What’s different now is the patients carrying the most financial risk are largely invisible to the systems providers use to manage it." 

Most billing systems today are powered by static, credit-based scores that predict a patient's likelihood to pay. These models guide how providers prioritize accounts, design payment options, and decide who receives outreach. But they were built for a more stable coverage and financial environment. As patient circumstances become more dynamic, these systems are failing to adapt. 

The misalignment shows up in what patients are actually being offered: 30 percent say the payment options in front of them are unaffordable, including four in ten who earn $100,000 or more. Even among commercially insured patients, one in four report difficulty paying medical bills.

“If you give someone a choice of paying $1,000 a month and they can’t afford $1,000 a month, that’s not a real choice,” said Doug Watson, Chief Financial Officer of Allina Health. “The more we can find a right fit for a patient personally — so they can do what they need to do for their family while still meeting their obligation — that’s just the right thing to do.”

For many patients, that support still does not exist within the provider experience. Half report already using AI tools to interpret medical bills or resolve billing questions, often after hours when billing offices are closed. The finding underscores a growing gap between the support patients need and the support providers are equipped to deliver.

"How do we anticipate what patients are thinking — or not thinking — and give them a full deck of information as they make choices?” said Watson. “ That's where AI can help us get smarter.” 

Read the full 2026 Healthcare Financial Experience Study.